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Showing 1 - 200 of 3163 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 394, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 244, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3, SJR: 0.732, CiteScore: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 385, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 436, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 43)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 203, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 174, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Journal Cover
American Journal of Ophthalmology
Journal Prestige (SJR): 3.184
Citation Impact (citeScore): 4
Number of Followers: 62  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9394
Published by Elsevier Homepage  [3163 journals]
  • Altered Macular Microvasculature in Neuromyelitis Optica Spectrum
    • Authors: William Robert Kwapong; Chenlei Peng; Zhiyong He; Xiran Zhuang; Meixiao Shen; Fan Lu
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): William Robert Kwapong, Chenlei Peng, Zhiyong He, Xiran Zhuang, Meixiao Shen, Fan Lu
      Purpose To evaluate macular microvascular changes in neuromyelitis optica spectrum disorders (NMOSD) by using optical coherence tomography angiography (OCT-A) and investigate their correlations with neuroaxonal structural damage evaluated with spectral-domain OCT (SD-OCT). Design Cross-sectional study. Methods Twenty eyes of 20 patients with NMOSD and 21 eyes from 21 healthy controls were enrolled. OCT-A was used to obtain microvascular network images of the whole, superficial, and deep retinal capillary plexuses (WRCP, SRCP, and DRCP) in a 3-mm-diameter area around the macula. SD-OCT was used to obtain the intraretinal thickness. Custom automated algorithms quantified the thickness of the intraretinal layers as well as microvascular density of the retinal capillary layers. Results NMOSD patients showed significantly decreased microvascular density in both SRCP and DRCP (P < .05) compared to controls. The decreased microvascular density in SRCP and DRCP significantly correlated with the frequency of optic neuritis attack (P < .05). Both SRCP and DRCP microvascular density significantly correlated (P < .05) with retinal nerve fiber layer and ganglion cell layer with inner plexiform layer. SRCP microvascular density moderately correlated with visual acuity, while a stronger correlation was found between DRCP and visual acuity. Conclusions Decreased microvascular density in NMOSD patients correlated with the worsening of their visual acuity. Correlation between microvascular impairment and neuroaxonal thinning revealed that retinal microvascular alteration may contribute to neuroaxonal loss in NMOSD patients. OCT-A with measurable analysis offers a new path of study and will likely be useful as an objective biomarker for detecting microvascular impairment in NMOSD.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.026
      Issue No: Vol. 192 (2018)
  • Glaucoma Specialist Optic Disc Margin, Rim Margin, and Rim Width
           Discordance in Glaucoma and Glaucoma Suspect Eyes
    • Authors: Seung Woo Hong; Helen Koenigsman; Ruojin Ren; Hongli Yang; Stuart K. Gardiner; Juan Reynaud; Robert M. Kinast; Steven L. Mansberger; Brad Fortune; Shaban Demirel; Claude F. Burgoyne
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Seung Woo Hong, Helen Koenigsman, Ruojin Ren, Hongli Yang, Stuart K. Gardiner, Juan Reynaud, Robert M. Kinast, Steven L. Mansberger, Brad Fortune, Shaban Demirel, Claude F. Burgoyne
      Purpose To quantify the variability of 5 glaucoma specialists' optic disc margin (DM), rim margin (RM), and rim width (RW) estimates. Design Inter-observer reliability analysis. Methods Clinicians viewed stereo-photographs from 214 subjects with glaucoma or ocular hypertension and digitally marked the DM and RM. For each photograph, the centroid of each clinician's DM was calculated, and an averaged DMcentroid was determined. The axis between the DMcentroid and the fovea was used to establish 12 30-degree sectors. Measurements from the DMcentroid to each clinician's DM (DMradius) and RM (RMradius) were used to generate a RW (DMradius–RMradius) and cup-to-disc ratio (CDR) (RMradius/DMradius) by sector. Parameter means, standard deviations, and coefficient of variations (COVs) were calculated across all clinicians for each eye. Parameter means for each clinician, and intraclass correlation coefficients (ICC), were calculated across all eyes by sector. Results Among all eyes, the median COV by sector ranged from 3% to 5% for DMradius, 20% to 25% for RMradius, and 26% to 30% for RW. Sectoral ICCs for CDR ranged from 0.566 to 0.668. Sectors suspicious for rim thinning by 1 clinician were frequently overlooked by others. Among 1724 sectors in which at least 1 clinician was suspicious for rim thinning (CDR ≥ 0.7), all 5 clinicians' CDRs were ≥ 0.7 in only 499 (29%), and 2 of the 5 clinicians failed to detect rim thinning (CDR < 0.7) in 442 (26%). Conclusion In this study, glaucoma specialist RM, DM, and RW discordance was frequent and substantial, even in sectors that were suspicious for rim thinning.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.022
      Issue No: Vol. 192 (2018)
  • Ellipsoid Zone Change According to Glaucoma Stage Advancement
    • Authors: Ahnul Ha; Young Kook Kim; Jin Wook Jeoung; Ki Ho Park
      Pages: 1 - 9
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Ahnul Ha, Young Kook Kim, Jin Wook Jeoung, Ki Ho Park
      Purpose To compare retinal photoreceptor ellipsoid zone (EZ) intensity between normal eyes and those with different stages of glaucoma. Design Retrospective cross-sectional study. Methods The study included 37 normal, 38 preperimetric glaucoma, 39 mild-to-moderate glaucoma (visual field [VF] mean deviation [MD]: −7.7 ± 2.0 dB), and 36 severe glaucoma eyes (VF MD: −17.8 ± 3.2 dB). The subjects underwent high-resolution horizontal and vertical line scans through the fovea by spectral-domain optical coherence tomography (SD-OCT). Image processing software was employed to quantify the intensity of the first and second hyperreflective bands corresponding with the external limiting membrane (ELM) and EZ. In order to account for the brightness variation among scans, the relative EZ intensity as the ratio of the second to first reflective band (EZ/ELM) was determined. Results The relative EZ intensity in severe glaucoma eyes was significantly lower than in mild-to-moderate glaucoma eyes (2.46 ± 0.38 vs 3.15 ± 0.43, P < .001); also, it was lower in mild-to-moderate than in preperimetric glaucoma eyes (3.15 ± 0.43 vs 3.86 ± 0.44, P < .001). However, the comparison between preperimetric glaucoma and normal eyes showed no significant difference (3.86 ± 0.44 vs 4.06 ± 0.40, P = .751). In 75 glaucomatous eyes with VF defect, there was a significant correlation between relative EZ intensity and VF MD (r = 0.83 and P < .001). Conclusions According to SD-OCT, relative EZ intensity reduction occurs in the mild-to-moderate and severe glaucoma stages. These findings suggest, at least provisionally, that in the course of glaucoma progression, mitochondrial changes in the inner segments of photoreceptors occur. Further investigation is warranted to evaluate the potential clinical significance of EZ intensity reduction in glaucoma.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.025
      Issue No: Vol. 192 (2018)
  • Topographic Correspondence of Macular Atrophy With Choroidal
           Neovascularization in Ranibizumab-treated Eyes of the TREX-AMD Trial
    • Authors: Nizar Saleh Abdelfattah; Amir H. Hariri; Mayss Al-Sheikh; Sean Pitetta; Adel Ebraheem; Charles C. Wykoff; SriniVas R. Sadda; Charles C. Wykoff; Daniel E. Croft; David M. Brown; Rui Wang; John F. Payne; Lloyd Clark; Nizar Saleh Abdelfattah; SriniVas R. Sadda; Matthew S. Benz; Eric Chen; Richard H. Fish; David L. Johnson; Rosa Y. Kim; James C. Major; Ronan E. O'Malley; Amy C. Schefler; Ankoor R. Shah; Sushma K. Vance; John A. Wells; Tien P. Wong
      Pages: 84 - 90
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Nizar Saleh Abdelfattah, Amir H. Hariri, Mayss Al-Sheikh, Sean Pitetta, Adel Ebraheem, Charles C. Wykoff, SriniVas R. Sadda
      Purpose To quantify the extent of topographic correspondence between baseline (BSL) choroidal neovascularization (CNV) and macular atrophy (MA) at follow-up in eyes with neovascular age-related macular degeneration (NVAMD). Design Post hoc analysis of randomized controlled clinical trial data. Methods Sixty treatment-naïve NVAMD patients from the TREX-AMD trial were followed for 18 months. Regions of month 18 macular atrophy (MA) were graded on fundus autofluorescence (FAF) with guidance of spectral-domain optical coherence tomography (SDOCT). CNV lesions were graded manually on fluorescein angiography (FA) with lesion components including classic and occult CNV delineated. FAF and FA images were registered to quantitate area and location of overlap between CNV and MA. Outcome measures included overlap of month 18 MA to BSL CNV subtype and progression of MA from BSL to month 18. Results Twenty-six eyes had both MA at month 18 and CNV at BSL. A total of 84.6% of eyes showed evidence of MA and CNV overlap. MA appeared by month 18 in regions corresponding to BSL classic CNV in 36.4% of eyes and occult CNV in 40.9%, and in both regions in 22.7%, with more area of MA (AMA) in regions of occult than classic CNV. MA position at BSL corresponded to BSL classic CNV in 76.9% of eyes and occult CNV in 61.5%, and to both regions in 15.4%, with more AMA in regions of occult than classic CNV. Among eyes with MA and CNV at BSL but with no overlap, 50% progressed to involve regions with BS -CNV. Six eyes had no BSL MA but developed MA at month 18 within regions of BSL CNV. Conclusions In ranibizumab-treated eyes with NVAMD, more MA lesions develop within the region of baseline CNV (type 1, CNV-based MA) than outside (type 2, CNV-independent MA). Baseline-MA also tends to be located within regions of CNV in the pretreatment phase.

      PubDate: 2018-06-02T15:35:54Z
      DOI: 10.1016/j.ajo.2018.05.008
      Issue No: Vol. 192 (2018)
  • Risk of Glaucoma Surgery After Corneal Transplant Surgery in Medicare
    • Authors: Chengjie Zheng; Fei Yu; Victoria L. Tseng; Flora Lum; Anne L. Coleman
      Pages: 104 - 112
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Chengjie Zheng, Fei Yu, Victoria L. Tseng, Flora Lum, Anne L. Coleman
      Purpose Glaucoma is a well-documented complication of corneal transplants, contributing significantly to ultimate visual loss. Reported incidence of glaucoma following corneal transplants is highly variable, and definitions of posttransplant glaucoma are inconsistent. Here we use glaucoma surgery as a more rigid and specific endpoint to compare rates following different corneal transplant surgeries. Design Retrospective cohort study. Methods A 5% random sample of Medicare beneficiaries from 2010-2013 was obtained and patients were identified with Current Procedural Terminology (CPT) codes for penetrating keratoplasty (PK), endothelial keratoplasty (EK), anterior lamellar keratoplasty (ALK), and keratoprosthesis (KPro). Rates of glaucoma surgery within the same year following the abovementioned corneal transplants were analyzed. Subgroup analyses included patients who carried preexisting glaucoma diagnoses prior to corneal transplant surgery. Results There were 3098 patients who underwent corneal transplants during the study period, including 1919 EK, 1012 PK, 46 ALK, 32 KPro, and 89 both PK and EK. Rates of glaucoma surgery ranged from 6.1% to 9.4% in the corneal transplant groups, without statistically significant differences among groups. However, 10.0% of patients with preexisting glaucoma required glaucoma surgery following any transplant surgery, compared with 5.3% of patients without preexisting glaucoma. This included 12.4% of PK patients with preexisting glaucoma compared with 2.8% of PK patients without preexisting glaucoma (P < .01). Conclusions Despite literature suggesting that more angle-altering cornea surgeries confer higher risk, we found no statistically significant differences among various transplant groups. Patients with preexisting glaucoma, however, had higher risk of glaucoma surgery within the same year following corneal transplant surgery, which was especially pronounced in the PK group. These patients require special care when considering long-term effects of corneal transplants.

      PubDate: 2018-06-05T15:40:48Z
      DOI: 10.1016/j.ajo.2018.05.004
      Issue No: Vol. 192 (2018)
  • A Randomized, Controlled Phase I/II Study to Evaluate the Safety and
           Efficacy of MGV354 for Ocular Hypertension or Glaucoma
    • Authors: Rebecca Stacy; Kenneth Huttner; Jen Watts; James Peace; David Wirta; Tom Walters; Kenneth Sall; John Seaman; Xiao Ni; Ganesh Prasanna; Muneto Mogi; Christopher Adams; Jing-He Yan; Michael Wald; Yunsheng He; Ronald Newton; Randall Kolega; Cynthia Grosskreutz
      Pages: 113 - 123
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Rebecca Stacy, Kenneth Huttner, Jen Watts, James Peace, David Wirta, Tom Walters, Kenneth Sall, John Seaman, Xiao Ni, Ganesh Prasanna, Muneto Mogi, Christopher Adams, Jing-He Yan, Michael Wald, Yunsheng He, Ronald Newton, Randall Kolega, Cynthia Grosskreutz
      Purpose To assess the clinical safety, tolerability, and efficacy of topically administered MGV354, a soluble guanylate cyclase (sGC) activator, in patients with ocular hypertension (OH) or glaucoma. Design Double-masked, randomized, and vehicle-controlled study. Methods Parts 1 and 2 evaluated safety and tolerability to identify the maximum tolerated dose (MTD) of once-daily MGV354 in 32 healthy volunteers (Part 1) and 16 patients with OH or glaucoma (Part 2) at a single clinical site. Part 3 was a multisite trial that evaluated intraocular pressure (IOP)-lowering efficacy of the MTD administered nightly for 1 week in 50 patients with minimum IOP of 24 mm Hg at 8 AM, with a main outcome measure of mean diurnal IOP at day 8 compared to baseline ( NCT02743780). Results There was no difference in favor of MGV354 for IOP lowering; change from baseline to day 8 in mean diurnal IOP was -0.6 mm Hg for MGV354-treated patients and -1.1 mm Hg for vehicle-treated patients in Part 3, with a confidence interval of -0.7 to 1.7. The most common adverse events reported after MGV354 administration were conjunctival and ocular hyperemia. Conclusions Overall, MGV354 0.1% demonstrated no statistically significant effect compared to vehicle in lowering IOP based on the study's main outcome measure. MGV354 produced ocular hyperemia consistent with its pharmacology.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.015
      Issue No: Vol. 192 (2018)
  • Breastfeeding and Maternal Age-related Cataract
    • Authors: Sangshin Park; Nam-Kyong Choi
      Pages: 124 - 130
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Sangshin Park, Nam-Kyong Choi
      Purpose No studies addressed the influence of breastfeeding on cataract formation. The objective of this study was to address the relationship between breastfeeding and maternal age-related cataract. Design A nationwide cross-sectional study. Methods This study analyzed data for 3821 parous women aged 50 years or above in the Korea National Health and Nutrition Examination Survey 2010-2012. Participants were aggregated into quartiles according to the number of breastfed children and duration of breastfeeding. Logistic regression analysis was used to examine the relationships between less or short duration of breastfeeding and increased risks of cataract. Results A total of 2197 women (57.5%) were classified as having age-related cataract. Women who breastfed 4-12 children (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.35–0.89) had significantly lower risks for cortical cataract, compared to those who breastfed no or 1 child (P for trend across quartiles = .010). Women who breastfed for 36-60 months (OR = 0.61, 95% CI = 0.42–0.90) or 61-324 months (OR = 0.53, 95% CI = 0.33–0.83) had lower risks for cortical cataract compared to those who breastfed 16 months or less (P for trend across tertiles = .003). The population-attributable fractions of cortical cataract induced by number of children breastfed less than 3 and duration of breastfeeding less than 36 months were 9.4% (95% CI = 1.3%–17.6%) and 10.7% (95% CI = 3.0%–18.4%), respectively. Conclusions Breastfeeding more children and long-term breastfeeding were associated with lower risk of cortical cataract formation in parous women.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.017
      Issue No: Vol. 192 (2018)
  • Locations, Circumstances, and Outcomes of Falls in Patients With Glaucoma
    • Authors: Ayodeji E. Sotimehin; Andrea V. Yonge; Aleksandra Mihailovic; Sheila K. West; David S. Friedman; Laura N. Gitlin; Pradeep Y. Ramulu
      Pages: 131 - 141
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Ayodeji E. Sotimehin, Andrea V. Yonge, Aleksandra Mihailovic, Sheila K. West, David S. Friedman, Laura N. Gitlin, Pradeep Y. Ramulu
      Purpose To characterize the locations, circumstances, and outcomes of falls in patients with varying degrees of glaucoma. Design Prospective cohort study. Methods Patients with suspected or diagnosed glaucoma completed monthly calendars reporting falls. After each fall, a 30-item questionnaire was administered to determine fall location, circumstances, and injury. Mean deviation on visual field (VF) testing was used to categorize glaucoma severity. Main outcome measures were fall locations, circumstances, and outcomes. Results One-hundred forty-two patients experienced 330 falls. Falls were most likely to occur in/around the home (71%), and this likelihood did not vary significantly with severity of VF damage (P > .2). The most commonly cited fall circumstances were tripping (43.6%), slipping (31.3%), uneven flooring (23.5%), and poor vision (15.9%). The circumstances related to falls did not vary by severity of VF damage (P > .2), except for poor vision, which was more frequently cited in individuals with more advanced VF damage (P = .001). Forty-three percent of falls resulted in some injury; and the likelihood of injury did not vary by severity of VF loss (P = .60) or any other factor except floor type and number of comorbidities (P < .05 for all). Falls in persons with more severe glaucoma were more likely to result in a fracture (9.4%) or an emergency room visit (18.8%), though these associations did not persist in multivariable models (P > .5 for all). Conclusions Glaucoma patients fall mostly in/around the home and demonstrate similar fall circumstances across the spectrum of disease severity, suggesting that current fall prevention interventions, particularly those emphasizing home modification, may be an adequate starting point to prevent falls in this high-risk-group.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.04.024
      Issue No: Vol. 192 (2018)
  • Therapeutic Penetrating Keratoplasty Button Cultures in The Mycotic Ulcer
           Treatment Trial II: A Randomized Trial Comparing Oral Voriconazole Versus
    • Authors: Julie Cho; N. Venkatesh Prajna; Prajna Lalitha; Revathi Rajaraman; Tiruvengada Krishnan; Yijie (Brittany) Lin; Kathryn J. Ray; Thomas M. Lietman; Jennifer Rose-Nussbaumer; N. Venkatesh Prajna; Prajna Lalitha; Jeena Mascarenhas; Muthiah Srinivasan; Manoranjan Das; Rajarathinam Karpagam; Malaiyandi Rajkumar; S.R. Sumithra; C. Sundar; Revathi Rajaraman; Anita Raghavan; P. Manikandan; K.Tiruvengada Krishnan; N. Shivananda; R. Meenakshi; J. Bharathi; E. Raja; Byanju Raghunandan; Kamal Bahadur Khadka; Ranjeet Shah; Anju Ligal; Thomas M. Lietman; Nisha R. Acharya; Stephen D. McLeod; Jennifer Rose-Nussbaumer; John P. Whitcher; Travis C. Porco; Salena Lee; Vicky Cevallos; Brett L. Shapiro; Catherine E. Oldenburg; Kieran S. O’Brien; Kevin C. Hong; Sushila Patel; Salma K.C. Rai; Bel Bahadur Thapa; Binita Bhattarai; Ramesh C. Giri; Abhijeet Sarkar; Santosh Ghimire; Krishna Kunwar; Roji Yadav; Srijana S. Gautam; Sandeep Bashyal; Rojina Begam; Amar Gautam; Marian Fisher; Anthony Aldave; Donald Everett; Jacqueline Glover; K. Ananda Kannan; Steven Kymes; Ivan Schwab; Thomas M. Lietman; Nisha R. Acharya; Stephen D. McLeod; Jennifer Rose-Nussbaumer; John P. Whitcher; Travis C. Porco; David Glidden; Salena Lee; Kathryn Ray; Vicky Cevallos; Brett L. Shapiro; Catherine E. Oldenburg; Kieran S. O’Brien; Kevin C. Hong; Donald Everett; Michael E. Zegans; Christine M. Kidd
      Pages: 142 - 145
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Julie Cho, N. Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Tiruvengada Krishnan, Yijie (Brittany) Lin, Kathryn J. Ray, Thomas M. Lietman, Jennifer Rose-Nussbaumer
      Objective To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. Methods Study Participants: Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). Intervention: Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. Main Outcome Measures: TPK button culture positivity. Results A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fungal culture positivity (95% confidence interval [CI] 0.90–0.98, P = .005). Those randomized to oral voriconazole had 1.26-fold increased odds of TPK button culture positivity after controlling for time to TPK and baseline organism, but this was not statistically significant (95% CI 0.32–4.87; P = .74). Those who underwent TPK for lack of response to medical therapy were 10.64-fold more likely to be culture positive than if the indication for surgery was perforation and this was statistically significant (95% CI 2.16–51.70; P = .003). Conclusions There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. Infection rather than inflammation appears to be the reason for the worsening clinical picture in many of these patients.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.007
      Issue No: Vol. 192 (2018)
  • Characteristics of Neovascularization in Early Stages of Proliferative
           Diabetic Retinopathy by Optical Coherence Tomography Angiography
    • Authors: Jiandong Pan; Ding Chen; Xiaoling Yang; Ruitao Zou; Kuo Zhao; Dan Cheng; Shenghai Huang; Tingye Zhou; Ye Yang; Feng Chen
      Pages: 146 - 156
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Jiandong Pan, Ding Chen, Xiaoling Yang, Ruitao Zou, Kuo Zhao, Dan Cheng, Shenghai Huang, Tingye Zhou, Ye Yang, Feng Chen
      Purpose To classify retinal neovascularization in untreated early stages of proliferative diabetic retinopathy (PDR) based on optical coherence tomography angiography (OCTA). Design A cross-sectional study. Methods Thirty-five eyes were included. They underwent color fundus photography, fluorescein angiography (FA), and OCTA examinations. Neovascularizations elsewhere (NVEs), neovascularizations at the disc (NVDs), and intraretinal microvascular abnormalities (IRMAs) were scanned by OCTA. The origin and morphology of NVE/NVD/IRMA on OCTA were evaluated. Retinal nonperfusion areas (NPAs) were measured using ImageJ software. Results In 35 eyes successfully imaged, 75 NVEs, 35 NVDs, and 12 IRMAs were captured. Three proposed subtypes of NVE were identified based on the origins and morphologic features. Type 1 (32 of 75, 42.67%) originated from the venous side, in a tree-like shape. Type 2 (30 of 75, 40.00%) originated from capillary networks, with an octopus-like appearance. Type 3 (13 of 75, 17.33%) originated from the IRMAs, having a sea fan shape. NVD originated from the retinal artery, from the retinal vein, or from the choroid, and arose from the bending vessels near the rim of the optic disc. IRMA originated from and drained into retinal venules, extending into the retina. The initial layer and affiliated NPA were significantly different in the 3 subtypes of NVEs (all P < .01). Conclusions OCTA allowed identification of the origins and morphologic patterns of neovascularization in PDR. The new classification of retinal neovascularization may be useful to better understand pathophysiological mechanisms and to guide efficient therapeutic strategies.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.018
      Issue No: Vol. 192 (2018)
  • Vision Outcomes Following Anti–Vascular Endothelial Growth Factor
           Treatment of Diabetic Macular Edema in Clinical Practice
    • Authors: Nancy M. Holekamp; Joanna Campbell; Arghavan Almony; Herbert Ingraham; Steven Marks; Hitesh Chandwani; Ashley L. Cole; Szilárd Kiss
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Nancy M. Holekamp, Joanna Campbell, Arghavan Almony, Herbert Ingraham, Steven Marks, Hitesh Chandwani, Ashley L. Cole, Szilárd Kiss
      Purpose To determine monitoring and treatment patterns and vision outcomes in real-world patients initiating anti–vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME). Design Retrospective interventional cohort study. Methods Setting : Electronic medical record analysis of Geisinger Health System data. Study Population : A total of 110 patients (121 study eyes) initiating intravitreal ranibizumab or bevacizumab for DME during January 2007‒May 2012, with baseline corrected visual acuity of 20/40 to 20/320, and ≥1 ophthalmologist visit during follow-up. Main Outcome Measures : Intravitreal injections per study eye during the first 12 months; corrected visual acuity, change in corrected visual acuity from baseline, proportions of eyes with ≥10 or ≥15 approximate Early Treatment Diabetic Retinopathy Study letter gain/loss at 12 months; number of ophthalmologist visits. Results Over 12 months, mean number of ophthalmologist visits was 9.2; mean number of intravitreal injections was 3.1 (range, 1–12), with most eyes (68.6%) receiving ≤3 injections. At 12 months, mean corrected visual acuity change was +4.7 letters (mean 56.9 letters at baseline); proportions of eyes gaining ≥10 or ≥15 letters were 31.4% and 24.0%, respectively; proportions of eyes losing ≥10 or ≥15 letters were 10.8% and 8.3%, respectively. Eyes receiving adjunctive laser during the first 6 months (n = 33) showed similar change in corrected visual acuity to non–laser-treated eyes (n = 88) (+3.1 vs +5.3 letters at 12 months). Conclusions DME patients receiving anti-VEGF therapy in clinical practice undergo less frequent monitoring and intravitreal injections, and achieve inferior vision outcomes to patients in landmark clinical trials.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.010
      Issue No: Vol. 191 (2018)
  • Visual Outcomes After Implantation of a Segmental Refractive Multifocal
           Intraocular Lens Following Cataract Surgery
    • Authors: Thomas Kohnen; Eva Hemkeppler; Michael Herzog; Sabrina Schönbrunn; Nina DeLorenzo; Kerstin Petermann; Myriam Böhm
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Thomas Kohnen, Eva Hemkeppler, Michael Herzog, Sabrina Schönbrunn, Nina DeLorenzo, Kerstin Petermann, Myriam Böhm
      Purpose To evaluate visual outcomes, with particular attention to intermediate visual acuity (VA), of a segmental refractive multifocal intraocular lens (IOL) with optimized depth of focus (DoF). Design Prospective, nonrandomized, noncomparative case series. Methods Setting : Department of Ophthalmology, Goethe University, Frankfurt/Germany. Patient or Study Population : Fifty eyes (25 patients) were included. Inclusion criteria were bilateral cataract, age > 45 years, corneal astigmatism ≤ 0.75 diopter (D) postoperatively, pupil size 3–6 mm (mesopic), and center shift < 1 mm (Pentacam). Exclusion criteria were ocular surgeries, amblyopia, or potential postoperative distance-corrected VA (DCVA) > 0.3 logMAR. Intervention or Observation : Uncorrected (UCVA) and DCVA in 4 m, 80 cm, 40 cm; contrast sensitivity (CS); reading skills; defocus curve; and questionnaire on optical quality (OQ) and spectacle independence were assessed after 3 months. Main Outcome Measures : UCVA and DCVA in 4 m, 80 cm, 40 cm; defocus curve. Results UCVA was 0.05 ± 0.122 logMAR at 4 m, 0.18 ± 0.164 logMAR at 80 cm, and 0.16 ± 0.140 logMAR at 40 cm. Defocus curve testing showed, respectively, a flat monocular and binocular VA range from 0.00 to −2.00 D (−0.03 to 0.11 logMAR, −0.05 to 0.05 logMAR). Median CS under photopic and mesopic conditions without and with glare was 1.81 logCS, 1.65 logCS, 1.52 logCS, and 1.14 logCS, respectively. Reading speed at 40 cm showed a reading acuity of 0.100 logRAD with 94 words/minute. Conclusion This segmental multifocal IOL provides good VA at all distances (<0.20 logMAR), particularly providing good intermediate visual acuity and DoF. It showed good reading skills, OQ, and CS and high spectacle independence.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.011
      Issue No: Vol. 191 (2018)
  • Longitudinal Study of Visual Function in Vogt-Koyanagi-Harada Disease
           Using Full-Field Electroretinography
    • Authors: Wen Yuan; Chunjiang Zhou; Qingfeng Cao; Ziyu Du; Rong Hu; Yao Wang; Aize Kijlstra; Peizeng Yang
      Pages: 92 - 99
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Wen Yuan, Chunjiang Zhou, Qingfeng Cao, Ziyu Du, Rong Hu, Yao Wang, Aize Kijlstra, Peizeng Yang
      Purpose To investigate the dynamic changes of full-field electroretinography (ffERG) and its relationship with structural changes in Vogt-Koyanagi-Harada (VKH) disease. Design Interventional case series. Methods A total of 42 VKH patients (84 eyes) and 45 normal controls (90 eyes) were included in this study. All of the patients showed active uveitis and were referred to us within 2 months after disease onset. Dynamic changes of retinal function were evaluated by ffERG before treatment and 2, 6, and 12 months after treatment with systemic corticosteroids and cyclosporine. The relationship between ffERG data with structural changes as disclosed by B-scan ultrasonography, fundus fluorescein angiography (FFA), indocyanine green angiography, and optical coherence tomography were also evaluated. Results All investigated VKH patients showed a significantly decreased visual acuity and retinal structural changes before treatment. These changes significantly improved at 2 months and no abnormalities were apparent at 6 months following treatment. Full-field ERG showed significantly decreased amplitudes and prolonged implicit times for all dark-adapted (DA) and light-adapted ffERG responses before treatment. All these parameters, except the a-wave amplitude in the DA response, were improved at 2 months and returned to the normal level at 12 months. Conclusion Our findings show that ffERG is a more sensitive method to detect improvement of visual function in VKH following treatment when compared to corrected distance visual acuity and the various imaging techniques to detect structural abnormalities in VKH.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.013
      Issue No: Vol. 191 (2018)
  • Progressive Chronic Retinal Axonal Loss Following Acute Methanol-induced
           Optic Neuropathy: Four-Year Prospective Cohort Study
    • Authors: Olga Nurieva; Pavel Diblik; Pavel Kuthan; Petr Sklenka; Martin Meliska; Jan Bydzovsky; Jarmila Heissigerova; Pavel Urban; Katerina Kotikova; Tomas Navratil; Martin Komarc; Zdenek Seidl; Manuela Vaneckova; Daniela Pelclova; Sergey Zakharov
      Pages: 100 - 115
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Olga Nurieva, Pavel Diblik, Pavel Kuthan, Petr Sklenka, Martin Meliska, Jan Bydzovsky, Jarmila Heissigerova, Pavel Urban, Katerina Kotikova, Tomas Navratil, Martin Komarc, Zdenek Seidl, Manuela Vaneckova, Daniela Pelclova, Sergey Zakharov
      Purpose To study the dynamics and clinical determinants of chronic retinal nerve fiber layer thickness (RNFL) loss after methanol-induced optic neuropathy. Design Prospective cohort study. Methods All patients underwent complete ophthalmic evaluation including spectral-domain optical coherence tomography 3 times during 4 years of observation: 4.9 (±0.6), 25.0 (±0.6), and 49.9 (±0.5) months after discharge. Participants : Eighty-four eyes of 42 survivors of methanol poisoning, mean age (standard deviation) of 45.7 (±4.4) years; and 82 eyes of 41 controls, mean age 44.0 (±4.2) years. Main Outcome Measures : Global and temporal RNFL loss. Results Abnormal RNFL thickness was registered in 13 of 42 (31%) survivors of methanol poisoning and chronic axonal loss in 10 of 42 (24%) patients. Significant decrease of global/temporal RNFL thickness during the observation period was found in the study population compared to the controls (P < .001). The risk estimate of chronic global RNFL loss for arterial blood pH < 7.3 at admission was 11.65 (95% confidence interval 1.91–71.12) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated progressive visual loss in 7 of 10 cases. The patients with abnormal RNFL thickness had magnetic resonance signs of brain damage in 10 of 13 vs 8 of 29 cases with normal RNFL thickness (P = .003). Signs of brain hemorrhages were present in 7 of 13 patients with abnormal RNFL thickness vs 5 of 29 cases with normal RNFL thickness (P = .015). Conclusions Methanol-induced optic neuropathy may lead to chronic retinal axonal loss during the following years. Arterial blood pH on admission is the strongest predictor of chronic RNFL thickness decrease. Chronic retinal neurodegeneration is associated with the progressive loss of visual functions and necrotic brain lesions.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.015
      Issue No: Vol. 191 (2018)
  • Optical Coherence Tomography Angiography in Optic Disc Swelling
    • Authors: Masoud Aghsaei Fard; Jalil Jalili; Alireza Sahraiyan; Hassan Khojasteh; Marjane Hejazi; Robert Ritch; Prem S. Subramanian
      Pages: 116 - 123
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Masoud Aghsaei Fard, Jalil Jalili, Alireza Sahraiyan, Hassan Khojasteh, Marjane Hejazi, Robert Ritch, Prem S. Subramanian
      Purpose To compare optical coherence tomography angiography (OCT-A) of peripapillary total vasculature and capillaries in patients with optic disc swelling. Design Cross-sectional study. Methods Twenty nine eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION), 44 eyes with papilledema, 8 eyes with acute optic neuritis, and 48 eyes of normal subjects were imaged using OCT-A. Peripapillary total vasculature information was recorded using a commercial vessel density map. Customized image analysis with major vessel removal was also used to measure whole-image capillary density and peripapillary capillary density (PCD). Results Mixed models showed that the peripapillary total vasculature density values were significantly lower in NAION eyes, followed by papilledema eyes and control eyes, using commercial software (P < .0001 for all comparisons). The customized software also showed significantly lower PCD of NAION eyes compared with papilledema eyes (all P < .001), but did not show significant differences between papilledema and control subjects. Our software showed significantly lower whole image and PCD in eyes with optic neuritis than papilledema. There was no significant difference between NAION and optic neuritis using our software. The area under the receiver operating curves for discriminating NAION from papilledema eyes and optic neuritis from papilledema eyes was highest for whole-image capillary density (0.94 and 0.80, respectively) with our software, followed by peripapillary total vasculature (0.9 and 0.74, respectively) with commercial software. Conclusions OCT-A is helpful to distinguish NAION and papillitis from papilledema. Whole-image capillary density had the greatest diagnostic accuracy for differentiating disc swelling.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.017
      Issue No: Vol. 191 (2018)
  • Amblyopia in High Accommodative Convergence/Accommodation Ratio
           Accommodative Esotropia. Influence of Bifocals on Treatment Outcome
    • Authors: Jaime Tejedor; Francisco J. Gutiérrez-Carmona
      Pages: 124 - 128
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Jaime Tejedor, Francisco J. Gutiérrez-Carmona
      Purpose To study the influence of bifocal use on amblyopia treatment outcome in high accommodative convergence/accommodation (AC/A) ratio accommodative esotropia with deviation only at near. Design Retrospective comparative case series. Methods Setting : Tertiary referral center. Patients : Children with high AC/A ratio accommodative esotropia aged 3–8 years old, with deviation only at near with glasses, neutralized with bifocal lenses (follow-up 1 year). Intervention : Amblyopia was treated with patching. We compared bifocal and single-vision glasses users at 6 months and 1 year, with control of potential confounding variables (multiple regression). Main Outcome Measures : LogMAR lines of improvement in visual acuity of the amblyopic eye, and improvement in stereoacuity. Results Of 78 children, 61 were eligible. All patients wore single-vision glasses for 2 months (baseline visit), 46 of them changed to bifocals. Of 27 initially amblyopic children, 21 remained amblyopic at 2-month baseline (13 of them changed to bifocals). After adjustment for initial deviation, refraction, age, and amblyopia, improvement of visual acuity in the amblyopic eye was larger in the bifocal vs single-vision group at 6 months (mean 2.6 [95% confidence interval (CI): 1.9–2.9] logMAR lines vs mean 1.9 [95% CI: 0.5–2.2] logMAR lines, respectively, P = .01), but not at 1 year (mean 2.7 [95% CI: 2.2–3.1] logMAR lines vs mean 2.3 [95% CI: 1.6–3.1] logMAR lines, respectively, P = .3). Improvement of stereoacuity was not significantly different between the 2 groups. Conclusions Use of bifocals may provide a transient advantage, but improvement in visual acuity and stereopsis is equal with single-vision glasses over time.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.016
      Issue No: Vol. 191 (2018)
  • Comparing Change in Anterior Curvature After Corneal Cross-linking Using
           Scanning-slit and Scheimpflug Technology
    • Authors: Paul Z. Lang; Praneetha Thulasi; Sumitra S. Khandelwal; Farhad Hafezi; J. Bradley Randleman
      Pages: 129 - 134
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Paul Z. Lang, Praneetha Thulasi, Sumitra S. Khandelwal, Farhad Hafezi, J. Bradley Randleman
      Purpose To evaluate the correlation between anterior axial curvature difference maps following corneal cross-linking (CXL) for progressive keratoconus obtained from Scheimpflug-based tomography and Placido-based topography. Design Between-devices reliability analysis of randomized clinical trial data. Methods Corneal imaging was collected at a single-center institution preoperatively and at 3, 6, and 12 months postoperatively using Scheimpflug-based tomography (Pentacam; Oculus Inc, Lynnwood, Washington, USA) and scanning-slit, Placido-based topography (Orbscan II; Bausch & Lomb, Rochester, New York, USA) in patients with progressive keratoconus receiving standard protocol CXL (3 mW/cm2 for 30 minutes). Regularization index (RI), absolute maximum keratometry (K Max), and change in K Max (ΔK Max) were compared between the 2 devices at each time point. Results Fifty-one eyes from 36 patients were evaluated at all time points. Values were significantly different at all time points (56.01 ± 5.3 diopters [D] Scheimpflug vs 55.04 ± 5.1 D scanning-slit preoperatively [P = .003]; 54.58 ± 5.3 D Scheimpflug vs 53.12 ± 4.9 D scanning-slit at 12 months [P < .0001]) but strongly correlated between devices (r = 0.90–0.93) at all time points. The devices were not significantly different at any time point for either ΔK Max or RI but were poorly correlated at all time points (r = 0.41–0.53 for ΔK Max, r = 0.29–0.48 for RI). At 12 months, 95% limits of agreement were 7.51 D for absolute K Max, 8.61 D for ΔK Max, and 19.86 D for RI. Conclusions Measurements using Scheimpflug and scanning-slit Placido-based technology are correlated but not interchangeable. Both devices appear reasonable for separately monitoring the cornea's response to CXL; however, caution should be used when comparing results obtained with one measuring technology to the other.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.018
      Issue No: Vol. 191 (2018)
  • Automated Beta Zone Parapapillary Area Measurement to Differentiate
           Between Healthy and Glaucoma Eyes
    • Authors: Patricia Isabel C. Manalastas; Akram Belghith; Robert N. Weinreb; Jost B. Jonas; Min Hee Suh; Adeleh Yarmohammadi; Felipe A. Medeiros; Christopher A. Girkin; Jeffrey M. Liebmann; Linda M. Zangwill
      Pages: 140 - 148
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): Patricia Isabel C. Manalastas, Akram Belghith, Robert N. Weinreb, Jost B. Jonas, Min Hee Suh, Adeleh Yarmohammadi, Felipe A. Medeiros, Christopher A. Girkin, Jeffrey M. Liebmann, Linda M. Zangwill
      Purpose To evaluate whether automated assessment of beta zone parapapillary atrophy (βPPA) area can differentiate between glaucomatous and healthy eyes of varying axial lengths (AL). Design Cross-sectional study. Methods βPPA was automatically identified in glaucoma and healthy eyes with enhanced-depth imaging optical coherence tomography (OCT) optic nerve head (ONH) radial B-scans. Associations with AL and the presence of glaucoma were assessed. Manually delineated βPPA on individual OCT ONH B-scans of 35 eyes from the Diagnostic Innovations in Glaucoma Study served to validate the automated method. Results One hundred fifty-three glaucoma eyes (mean ± standard deviation) (visual field mean deviation, -5.0 ± 6.4 dB and mean AL, 25.1 ± 1.1 mm) and 73 healthy eyes (visual field mean deviation, 0.1 ± 1.4 dB and mean AL, 24.1 ± 1.1 mm) were included. In multivariable analysis, larger βPPA area was significantly associated with a diagnosis of glaucoma after controlling for age, central corneal thickness, and AL. Moreover, in multivariable analysis, the odds of having glaucoma were doubled for each 0.2 mm2 larger βPPA area. The age- and AL-adjusted area under the receiver operating characteristic curve (95% confidence interval) of βPPA area for differentiating between glaucoma and healthy eyes was 0.75 (0.68–0.81). Agreement for the location of the Bruch membrane opening and the location of retinal pigment epithelium tips was stronger between the automated technique and each individual observer than it was between the 2 observers. Conclusions Larger βPPA area, as determined by automated OCT assessment, is significantly associated with a diagnosis of glaucoma, even after adjusting for age and AL, and may aid in differentiating healthy from glaucomatous eyes.

      PubDate: 2018-05-28T15:19:19Z
      DOI: 10.1016/j.ajo.2018.04.021
      Issue No: Vol. 191 (2018)
  • Ocular Injury in United States Emergency Departments: Seasonality and
           Annual Trends Estimated from a Nationally Representative Dataset
    • Authors: David A. Ramirez; Travis C. Porco; Thomas M. Lietman; Jeremy D. Keenan
      Pages: 149 - 155
      Abstract: Publication date: July 2018
      Source:American Journal of Ophthalmology, Volume 191
      Author(s): David A. Ramirez, Travis C. Porco, Thomas M. Lietman, Jeremy D. Keenan
      Purpose To determine whether ocular trauma occurs more frequently in the summer months. Design Retrospective, cross-sectional study. Methods The Nationwide Emergency Department Sample (NEDS) is a large, publicly available administrative database that provides nationally representative estimates of emergency department (ED) visits in the United States. Billing codes from NEDS from 2006 to 2013 were used to identify all cases of ocular trauma, and the United States decennial census was used to estimate the population at risk for visiting an ED. The main outcome measures were the seasonal and annual trends in the incidence of ED-diagnosed eye trauma. Results Eye trauma was the primary diagnosis for an estimated 5 615 532 ED encounters over the 8-year study period. Those with an eye trauma encounter were predominantly male (66%) and under 60 years of age (91%). The most common ocular trauma presentations were superficial injury of eye and adnexa (101 ED-diagnosed cases per 100 000 population), extraocular foreign body (54 per 100 000 population), contusion of eye and adnexa (27 per 100 000 population), and ocular adnexal open wound (26 per 100 000 population). Each exhibited a statistically significant annual cycle, with a mean annual peak between May and July (P < .01 for each, Edwards test). Eye trauma visits decreased by an average of 4% per year over the study period, with a similar pattern of decline during each calendar month (incidence rate ratio 0.96, 95% confidence interval 0.94–0.98). Conclusions Eye trauma, although decreasing in incidence, is a seasonal condition. Prevention efforts would likely be most effective if implemented in the spring or summer months. Further study to identify other individual-level or regional-level factors that would most benefit from public health efforts is warranted.

      PubDate: 2018-06-02T15:35:54Z
      DOI: 10.1016/j.ajo.2018.04.020
      Issue No: Vol. 191 (2018)
  • Reproducibility of Vessel Density, Fractal Dimension, and Foveal Avascular
           Zone Using 7 Different Optical Coherence Tomography Angiography Devices
    • Abstract: Publication date: Available online 15 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Riccardo Sacconi, Enrico Borrelli, Giuseppe Querques

      PubDate: 2018-06-18T16:11:23Z
  • Cuban Epidemic optic neuropathy (1991-1993) And josé saramago’s
           novel blindness (1995)
    • Abstract: Publication date: Available online 12 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Robert M. Feibel, Jennifer Arch
      Purpose This article reviews the history of Cuban Epidemic Optic Neuropathy (1991-1993), which caused visual loss, peripheral neuralgias, and other neurological symptoms in over 50,000 persons, an incidence of almost 0.5% of the entire population. The clinical findings, etiology, and treatment are described. We then relate the Cuban epidemic to the fictional epidemic of contagious blindness depicted by Nobel Laureate José Saramago in his 1995 novel Blindness. This novel describes an unnamed modern city in which all inhabitants, except the ophthalmologist’s wife, are affected with a white, not black, blindness. Design Historical review and literary essay. Methods The sources for the Cuban epidemic were an extensive review of the published literature and personal communications with physicians who treated these patients. Both authors have analyzed the novel and the critical literature about Saramago’s writings. Results Though Saramago uses the epidemic of blindness as an allegory to comment on human weakness and immorality, he may also have known of the actual Cuban epidemic. Saramago was a lifelong member of the Communist party, as well as a friend of Fidel Castro and admirer of the Cuban government. We have no proof that Blindness was influenced by the Cuban epidemic, but we find it plausible. Conclusion It is valuable to examine the real and fictional epidemics side by side, not least because Saramago’s novel depicts the actions of an ophthalmologist during an epidemic of blindness. Ophthalmologists may be interested in a novel that uses the language of eyes, vision, sight, and blindness extensively.

      PubDate: 2018-06-18T16:11:23Z
  • Five year postoperative outcomes of Bilateral Aphakia and Pseudophakia in
           children upto 2 years of age: a Randomized Clinical Trial
    • Abstract: Publication date: Available online 12 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Abhay R. Vasavada, Vaishali Vasavada, Sajani K. Shah, M.R. Praveen, Viraj A. Vasavada, Rupal H. Trivedi, Farida Rawat, Archana Koul
      Purpose Comparative evaluation of complications and visual outcomes following bilateral congenital cataract surgery in children upto 2 years of age with and without primary intraocular lens (IOL) implantation at 5 years follow-up Design Randomized, controlled, clinical trial Methods 60 children (120 eyes) upto 2 years of age undergoing bilateral congenital cataract surgery randomized to: group 1, primary aphakia (n=30) or group 2,primary IOL implantation (n=30). Single surgeon performed surgeries with identical surgical technique. All patients were followed up regularly until 5 years postoperatively. At each follow-up, glaucoma, visual axis obcuration (VAO) requiring surgery, inflammation (cell deposits, posterior synechiae) were assessed. Visual acuity was assessed until 5 years followup. The first operated eye was selected for statistical analysis. Results Median age of the patients at time of surgery was 5.11 months (Aphakia), and 6.01 months (Pseudophakia) (P=0.56). 5 years postoperatively, incidence of glaucoma was 16% and 13.8% in groups 1 and 2; (P=0.82). Incidence of posterior synechiae was significantly more in pseudophakia group (27.6%) compared to aphakia group (8%) (P=0.004). VAO requiring surgery was seen in 8% and 10.3% eyes in groups 1 and 2 (P=0.76). Mean LogMAR visual acuity at 5 years followup:0.59+0.33 and 0.5+0.23 in groups 1 and 2 respectively (P=0.79). However, more eyes in pseudophakic group started giving documentable vision earlier in their postoperative followups. Conclusion Incidence of postoperative complications was comparable between the groups, except for a higher incidence of posterior synechiae in pseudophakic eyes. Visual rehabilitation was faster in pseudophakic group.

      PubDate: 2018-06-18T16:11:23Z
  • Longitudinal Changes of Fixation Location and Stability within 12 Months
           in Stargardt Disease: ProgStar Report No. 12
    • Authors: Etienne M. Schönbach; Rupert W. Strauss; Xiangrong Kong; Beatriz Muñoz; Mohamed A. Ibrahim; Janet S. Sunness; David G. Birch; Gesa-Astrid Hahn; Fadi Nasser; Eberhart Zrenner; SriniVas R. Sadda; Sheila K. West; Hendrik P.N. Scholl
      Abstract: Publication date: Available online 8 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Etienne M. Schönbach, Rupert W. Strauss, Xiangrong Kong, Beatriz Muñoz, Mohamed A. Ibrahim, Janet S. Sunness, David G. Birch, Gesa-Astrid Hahn, Fadi Nasser, Eberhart Zrenner, SriniVas R. Sadda, Sheila K. West, Hendrik P.N. Scholl
      Purpose To investigate the natural history of Stargardt disease (STGD1) using fixation location and fixation stability. Design Multicenter, international, prospective cohort study. Methods Fixation testing was performed using the Nidek MP-1 microperimeter as part of the prospective, multicenter, natural history study on the Progression of Stargardt disease (ProgStar). A total of 238 patients with ABCA4-related STGD1 were enrolled at baseline (bilateral enrollment in 86.6 %) and underwent repeat testing at month 6 and 12. Results Outcome measures included the distance of the preferred retinal locus from the fovea (PRL) and the bivariate contour ellipse area (BCEA). After 12 months of follow-up, the change in the eccentricity of the PRL from the anatomical fovea was -0.0014 deg (95 % CI, - 0.27deg - 0.27 deg; p = 0.99). The deterioration in the stability of fixation as expressed by a larger BCEA encompassing 1 SD of all fixation points was 1.21 deg 2 (95 % CI, -1.23 deg 2 , 3.65 deg 2 ; p = 0.33). Eyes with increases and decreases in PRL eccentricity and/or BCEA values were observed. Conclusions Our observations point to the complexity of fixation parameters. The association of increasingly eccentric and unstable fixation with longer disease duration that is typically found in cross-sectional studies may be countered within individual patients by poorly understood processes like neuronal adaptation. Nevertheless, fixation parameters may serve as useful secondary outcome parameters in selected cases and for counseling patients to explain changes to their visual functionality.

      PubDate: 2018-06-11T16:00:16Z
      DOI: 10.1016/j.ajo.2018.06.003
  • Inner nuclear layer thickness, a biomarker of metamorphopsia in epiretinal
           membrane, correlates with tangential retinal displacement
    • Authors: Yoshikazu Ichikawa; Yutaka Imamura; Masahiro Ishida
      Abstract: Publication date: Available online 8 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Yoshikazu Ichikawa, Yutaka Imamura, Masahiro Ishida
      Purpose To examine correlations of inner nuclear layer (INL) thickness with metamorphosia and tangential retinal displacement in epiretinal membrane (ERM). Design Retrospective, consecutive, interventional case series. Methods:Setting Institutional study Patient Population Fifty eyes of 50 patients undergoing epiretinal membrane surgery Observation Procedures M-CHARTS were used to measure metamorphopsia. Inner nuclear layer (INL) thickness and outer retinal layer (ORL) thickness in the macula and distances between the intersections of 2 sets of retinal vessels situated vertically or horizontally were measured in Spectralis OCT and infrared images. Main Outcome Measures Correlations of INL and ORL thicknesses with M- CHARTS scores and distances of retinal displacement Results Preoperative INL thickness significantly correlated with pre- and postoperative metamorphopsia scores at 3 months (Spearman’s correlation coefficient: P=.036 and P= .003, respectively). The baseline INL thickness and its change at 3 months significantly correlated with the postoperative vertical retinal displacements at 3 months (P< .001 for both). Pre- and postoperative ORL thicknesses were not correlated with pre- and postoperative metamorphopsia scores at any periods. Conclusions INL thickness is a useful biomarker to evaluate metamorphopsia and appears to be determined by tangential retinal displacement in ERM. Structural changes of inner retinal layer, which cause Müller cells distorted, play a more important role for generation of metamorphosia than outer retina. Our results provide evidence for the theory that Müller cell functions as an optic fiber in humans.

      PubDate: 2018-06-11T16:00:16Z
      DOI: 10.1016/j.ajo.2018.06.001
  • Material Analysis and Optical Quality Assessment of Opacified Hydrophilic
           Acrylic Intraocular Lenses after Pars Plana Vitrectomy
    • Authors: Timur M. Yildirim; Gerd U. Auffarth; Grzegorz Łabuz; Silvia Bopp; Hyeck-Soo Son; Ramin Khoramnia
      Abstract: Publication date: Available online 8 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Timur M. Yildirim, Gerd U. Auffarth, Grzegorz Łabuz, Silvia Bopp, Hyeck-Soo Son, Ramin Khoramnia
      Purpose Explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after pars plana vitrectomy (PPV) were assessed for material change and optical quality, in an in-vitro laboratory study. Design Retrospective observational case series. Methods 10 opacified IOLs after PPV with intraocular gas injection were analyzed in a laboratory setting. Analyses included evaluation of patients’ medical history, optical quality assessment, light microscopy, histological staining, scanning electron microscopy and energy dispersive X-Ray spectroscopy. Results In all 10 IOLs a thin layer of calcium phosphate that had accumulated underneath either the anterior or posterior optical surface in a central circular area of the IOL optic caused the opacification. The calcifications lead to deterioration of the modulation transfer function (MTF) across all spatial frequencies. Conclusion PPV with instillation of gas into a pseudophakic eye with an acrylic hydrophilic lens seems to increase the risk for secondary calcification irrespective of the manufacturer. In these cases, IOL exchange is the only treatment option available. Since IOL exchange is associated with a high intraoperative complication rate, our results suggest to consider the risk of IOL calcification when implanting hydrophilic acrylic IOLs.

      PubDate: 2018-06-11T16:00:16Z
      DOI: 10.1016/j.ajo.2018.06.002
  • Corneal Ectasia in Steven Johnson Syndrome: A Sequelae of Chronic Disease
    • Authors: Prafulla K. Maharana; Pranita Sahay; Sagnik Sen; Renu Venugopal; Jeewan S. Titiyal; Namrata Sharma
      Abstract: Publication date: Available online 8 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Prafulla K. Maharana, Pranita Sahay, Sagnik Sen, Renu Venugopal, Jeewan S. Titiyal, Namrata Sharma
      Purpose To describe corneal ectasia in cases of chronic Steven Johnson Syndrome (SJS) Design Prospective observational study Method Setting Institutional Patient Fifteen consecutive cases of chronic SJS Main Outcome Measures Best corrected distance visual acuity (BCDVA), Kmax, anterior elevation, posterior elevation, thinnest pachymetry and Sotozono severity score Results 30 eyes of fifteen patients were included. Corneal tomography using Scheimpflug technology (Pentacam-HR, Oculus GmbH) was performed. Nine eyes were excluded due to poor quality scans. The median age was 26 years. The median time from onset of disease to assessment for corneal ectasia was 7 years. The median BCDVA was 0.8 logMAR units at presentation. The median Sotozono severity score was 11. Corneal ectasia (Kmax >48D) was noted in 76.2% of eyes. The mean Kmax was 58.37±14.89 D. On Belin-Ambrosio enhanced ectasia display the median front and back elevation was 42 μm (10-176 μm) and 267 μm (15-2392μm) respectively. The mean pachymetry was 377.76 ±165.05 μm (133-448 μm). The point of maximum ectasia was peripheral in 57.1%, both central and peripheral in 19.1 % and central in 23.8% of eyes. On Spearman’s correlation analysis, deterioration in BCDVA (R= 0.759, p <0.001) and increase in Kmax (R = 0.589, p = 0.005) was associated with higher disease severity (Sotozono grading). Conclusion Corneal ectasia is a common but often missed entity in cases of chronic SJS that may be a cause for poor visual acuity in these cases. All cases of SJS must be evaluated for corneal ectasia, especially when the visual acuity is disproportionate to the disease severity.

      PubDate: 2018-06-11T16:00:16Z
      DOI: 10.1016/j.ajo.2018.05.030
  • Topographic Macular Microvascular Changes and Correlation with Visual Loss
           in Chronic Leber’s Hereditary Optic Neuropathy
    • Authors: Enrico Borrelli; Siva Balasubramanian; Giacinto Triolo; Piero Barboni; SriniVas R. Sadda; Alfredo A. Sadun
      Abstract: Publication date: Available online 7 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Enrico Borrelli, Siva Balasubramanian, Giacinto Triolo, Piero Barboni, SriniVas R. Sadda, Alfredo A. Sadun
      Purpose To study the macular microvascular networks in patients affected by chronic Leber’s hereditary optic neuropathy (LHON) using optical coherence tomography angiography (OCTA), and to quantify these changes in different macular sectors. Design Prospective cross-sectional study. Methods Patients with a clinical and molecularly confirmed diagnosis of LHON (affected patients in the chronic stage) were enrolled from the neuro-ophthalmology clinic at the Doheny-UCLA. Patients and controls underwent a complete ophthalmologic evaluation, including imaging with OCTA. Results Twenty-nine eyes from 15 LHON patients (14 males) and 20 eyes from 20 healthy subjects (13 males) were included in the analysis. Mean age was 32.0±14.2 years [range 16-49 years] in the LHON group, and 34.2±10.1 years [range 23-48 years] in the control group (p=.552). In the parafoveal region, the vessel length density was lower in LHON patients, at both the SCP (9.1±0.5 % and 9.3±0.4 %, p=.041) and DCP (9.4±0.5 % and 9.8±0.3 %, p=.008) levels. In the sectorial analysis, vascular changes remained significant only in the parafoveal nasal and inferior regions. Univariate linear regression analysis demonstrated that the strongest associations with visual acuity were with parafoveal SCP perfusion density (R2=.276, p=.045) and parafoveal SCP vessel length density (R2=.277, p=.044). Conclusions LHON eyes have SCP and DCP changes which are mainly confined to the nasal and inferior parafoveal sectors that correspond to the papillomacular bundle. Furthermore, visual loss is associated with the SCP flow impairment, but not with the OCT-detectable structural damage.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.029
  • The treat-and-extend injection regimen versus alternate dosing strategies
           in age-related macular degeneration: a systematic review and meta-analysis
    • Authors: Mali Okada; Rathika Kandasamy; Elaine W. Chong; Myra McGuiness; Robyn H. Guymer
      Abstract: Publication date: Available online 6 June 2018
      Source:American Journal of Ophthalmology
      Author(s): Mali Okada, Rathika Kandasamy, Elaine W. Chong, Myra McGuiness, Robyn H. Guymer
      Purpose To assess outcomes of the treat-and-extend (T&E) injection regimen for neovascular age related macular degeneration (AMD) as compared to either a monthly or a pro-re-nata (PRN) treatment strategy. Design Systematic review and meta-analysis Methods Studies that compared the T&E regimen with either monthly or PRN dosing for treatment-naïve AMD were included. Trial eligibility, data extraction and risk of bias were assessed according to Cochrane review methods. Estimates were pooled using random effects meta-analysis. Results Four eligible studies were identified, all using ranibizumab (total n=940 eyes), including two randomized controlled trials comparing T&E to monthly and two retrospective reviews comparing T&E to PRN. No studies evaluating aflibercept were identified. Improvements in vision and central retinal thickness were similar between T&E and monthly at 12 months, with a mean difference of -1.79 letters (95% CI: 3.70, 0.13) and 3.76μm (95% CI: -13.78, 21.30) in favour of monthly injections. In contrast, visual gains were higher in the T&E compared to PRN group (difference of +6.18 letters, 95% CI: 3.28, 9.08). Fewer injections were required using the T&E regimen when compared to monthly (mean of -1.6 and -6.9 injections less at 12 and 24 months respectively). A mean of 1.44 more injections was required for the T&E compared to PRN regimen at 12 months, however this was achieved with fewer visits. Conclusion Despite the growing preference for the T&E regimen, there is limited head-to-head evidence comparing dosing strategies. The evidence available however, suggests that at 12 months, T&E is comparable to monthly and superior to PRN dosing for both efficacy and safety outcomes when using ranibizumab.

      PubDate: 2018-06-08T15:48:14Z
      DOI: 10.1016/j.ajo.2018.05.026
  • Macular Structures, Optical Components, and Visual Acuity in Preschool
           Children after Intravitreal Bevacizumab or Laser Treatment
    • Authors: Yung-Sung Lee; Lai-Chu See Shu-Hao Chang Nan-Kai Wang Yih-Shiou Hwang
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Yung-Sung Lee, Lai-Chu See, Shu-Hao Chang, Nan-Kai Wang, Yih-Shiou Hwang, Chi-Chun Lai, Kuan-Jen Chen, Wei-Chi Wu
      Purpose To investigate the macular structures, optical components, and visual acuity in preschool-aged children with a history of type I retinopathy of prematurity who underwent either intravitreal bevacizumab (IVB), laser, or a combination of treatments. Design Comparative interventional case series. Methods Setting: A referred medical center in Taiwan. Study Population: Eighty eyes from 42 patients (33 IVB-treated eyes from 17 children, 24 laser-treated eyes from 13 children, and 23 laser + IVB-treated eyes from 12 children). Observation Procedure: Spectral-domain optical coherence tomography. Main Outcome Measures: The retinal thickness in the foveal area and the associated morphologic changes in foveal depression. Results Compared with the laser-treated and laser + IVB-treated eyes, the IVB-treated eyes had less myopia and deeper anterior chamber depths but presented similar axial lengths and corneal curvatures (P = .001, P = .002, P = .95, and P = .16, respectively). The IVB-treated eyes had significantly thinner foveal, parafoveal, and perifoveal retinal thicknesses (P < .01 for all) and a higher incidence of foveal depression than the laser- or laser + IVB-treated eyes. The macular and subfoveal choroidal thicknesses did not differ among the groups (P = .21 and P = .63, respectively). Moreover, compared with the eyes treated with laser or laser + IVB, the IVB-treated eyes had better uncorrected visual acuity, although a significant difference was not observed in best-corrected visual acuity (P = .008 and P = .29, respectively). Conclusions Compared with laser therapy, IVB-treated eyes were associated with deeper anterior chamber depths and thinner foveal, parafoveal, and perifoveal thicknesses. Moreover, these IVB-treated eyes had fewer refractive errors and better uncorrected visual acuity.

      PubDate: 2018-05-28T15:19:19Z
  • Occurrence of Phosphenes in Patients Undergoing Proton Beam Therapy for
           Ocular Tumor
    • Authors: Thibaud Mathis; Petter Hofverberg Jean-Pierre Caujolle Leal Celia Maschi Benoit
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Thibaud Mathis, Petter Hofverberg, Jean-Pierre Caujolle, Joël Hérault, Cécilia Leal, Celia Maschi, Benoit Delaunay, Stéphanie Baillif, Laurent Kodjikian, Juliette Thariat
      Purpose Phosphenes are frequently reported by patients irradiated in the head and neck area. The aim of the present study was to characterize and investigate potential mechanisms of proton beam therapy (PBT)–induced phosphenes in a large population of patients undergoing PBT for ocular tumors. Design Prospective cohort study. Methods Consecutive patients who underwent PBT in a single center were included. Immediately after the first session, all patients completed a questionnaire collecting information about the presence of phosphenes as well as their color, shape, and duration. Patient, tumor and treatment characteristics (dose volume histograms) were also collected. Results Among the 474 patients included, 62.8% reported phosphenes during the first session of PBT. Reported colors were mainly blue-violet (70.5%) and white (14.1%). The prevalence of phosphenes was higher in younger patients (P = .003); other patient or ocular characteristics were not associated with the occurrence of phosphenes. Irradiation of the macula (P < .001) and/or optic disc (P < .001) were significantly associated with the presence of phosphenes, whereas blue-violet color was only associated with young age and irradiation of macular area (P = .04). Pupillary constriction was reported for 57.1% of patients with phosphenes vs 18.5% of patients without (P < .001). Blue-violet phosphenes (P < .001) and irradiation of macula (P = .001) were statistically associated with pupillary constriction. Conclusions The present study reported a high rate of phosphenes in patients irradiated by PBT for ocular tumor. Their blue-violet color and their association with a pupillary constriction probably indicates the stimulation of S-cones and retinal ganglion cells that reflects the activation of the afferent visual pathway.

      PubDate: 2018-05-28T15:19:19Z
  • Chloral Hydrate Administered by a Dedicated Sedation Service Can Be Used
           Safely and Effectively for Pediatric Ophthalmic Examination
    • Authors: Mohammed Karaoui; Varshini Varadaraj Beatriz Munoz Megan Collins Leyla Ali
      Abstract: Publication date: August 2018
      Source:American Journal of Ophthalmology, Volume 192
      Author(s): Mohammed Karaoui, Varshini Varadaraj, Beatriz Munoz, Megan E. Collins, Leyla Ali Aljasim, Esam Al Naji, Karam Hamweyah, Mohammed Al Shamrani, Earl Randy Craven, David S. Friedman
      Purpose To determine safety and efficacy of oral chloral hydrate sedation (CHS) for outpatient pediatric ophthalmic procedures. Design Prospective, interventional case series. Methods Setting: King Khaled Eye Specialist Hospital. Subjects: Children aged 1 month to 5 years undergoing CHS for ocular imaging/evaluation. Procedures: Details on chloral hydrate dose administered, sedation achieved, vital signs, and adverse events were recorded. Outcome Measures: Primary outcome was percentage of patients with a sedation level ≥ 4 at 45 minutes post chloral hydrate administration. Secondary outcomes were time from sedation to discharge and adverse events, including changes in vital signs following chloral hydrate administration. Results A total of 324 children were recruited with a mean age of 2.2 (SD: 1.3) years and mean weight of 10.9 (SD: 3.3) kg. Adequate sedation was obtained with a mean chloral hydrate first dose of 77.4 (SD: 14.7) mg/kg in 306 (94.4%) patients, with an additional 6 patients (1.9%) achieving adequate sedation with a second dose (overall adequate sedation: 96.3%). Mean reductions in heart rate, respiratory rate, and oxygen (O2) saturation from pre-sedation to 25 minutes post-sedation were 11.7 (SD: 14.3) beats per minute, 1.2 (SD: 2.4) breaths per minute, and 0.81% (SD: 1.2%), respectively (P < .001 for all). In multivariable regression, odds of remaining sedated 45 minutes after chloral hydrate administration were 2.53 times higher for American Society of Anesthesiologists (ASA) class II or III patients than for ASA class I (95% confidence interval [CI]: 1.11–5.78, P = .03), 1.03 times higher per mg increase in initial dose of chloral hydrate (95% CI: 1.01–1.06, P = .006), and 2.70 times higher per unit increase in number of planned procedures (95% CI: 1.63–4.47, P < .001). Three patients developed minor adverse events: 2 cases of O2 desaturation and 1 paradoxical reaction, none requiring significant intervention. Patients were discharged a median of 90 minutes after chloral hydrate administration. Conclusion Chloral hydrate administered by a dedicated sedation service, as in this prospective assessment, can be used safely and effectively for outpatient pediatric ophthalmic procedures.

      PubDate: 2018-05-28T15:19:19Z
  • Proton beam irradiation: a safe procedure in post-equatorial extraocular
           extension from uveal melanoma
    • Authors: Ira Seibel; Aline I. Riechardt; Katharina Erb-Eigner; Alexander Böker; Dino Cordini; Jens Heufelder; Antonia M. Joussen
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Ira Seibel, Aline I. Riechardt, Katharina Erb-Eigner, Alexander Böker, Dino Cordini, Jens Heufelder, Antonia M. Joussen
      Purpose This study was performed to show long-term outcomes concerning metastasis rates and local recurrence rates after primary proton beam therapy in uveal melanoma with posterior extraocular extension (EOE) with the main focus on optic nerve invasion. Design Retrospective case series Methods All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma with posterior EOE between July 1998 and August 2010 were included. EOE was either detected upon sonography at primary examination or during the surgical application of tantalum clips onto the sclera. Ultrasound was performed in each patient before surgery, and if EOE was detected, a magnetic resonance imaging (MRI) scan was performed to confirm EOE. All patients with tumors exceeding 6 mm in thickness or abutting the optic disc received a 1.5 Tesla MRI scan after clip surgery. To asses EOE during follow-up, either ultrasound examinations or—if initially detected only by MRI—MRI scans were performed during follow-up. Results A total of 27 patients underwent primary proton beam therapy. The EOE was separated into 3 growth types: Optic nerve infiltration in 10 patients, vortex vein infiltration in 9 patients, and transscleral growth post-equatorially in 8 patients. No local recurrences were found during the overall median follow-up of 80 months (11-168 months). Metastasis rates correlated with AJCC stages but not EOE volume. Conclusion This study shows that posterior EOE can safely be treated by proton beam therapy, even if the optic nerve is infiltrated. MRI enables safe detection of optic nerve invasion.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.006
  • Automated segmentation of lesions including subretinal hyperreflective
           material in neovascular age-related macular degeneration
    • Authors: Hyungwoo Lee; Kyung Eun Kang; Hyewon Chung; Hyung Chan Kim
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Hyungwoo Lee, Kyung Eun Kang, Hyewon Chung, Hyung Chan Kim
      Purpose To evaluate an automated segmentation algorithm with a convolutional neural network (CNN) to quantify and detect intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and subretinal hyperreflective material (SHRM) through analyses of spectral domain optical coherence tomography (SD-OCT) images from patients with neovascular age-related macular degeneration (nAMD). Design Reliability and validity analysis of a diagnostic tool. Methods We constructed a dataset including 930 B-scans from 93 eyes of 93 patients with nAMD. A CNN-based deep neural network was trained using 11550 augmented images derived from 550 B-scans. The performance of the trained network was evaluated using a validation set including 140 B-scans and a test set of 240 B-scans. The Dice coefficient, positive predictive value (PPV), sensitivity, relative area difference (RAD), and intraclass correlation coefficient (ICC) were used to evaluate segmentation and detection performance. Results Good agreement was observed for both segmentation and detection of lesions between the trained network and clinicians. The Dice coefficients for segmentation of IRF, SRF, SHRM, and PED were 0.78, 0.82, 0.75, and 0.80, respectively; the PPVs were 0.79, 0.80, 0.75, and 0.80, respectively; and the sensitivities were 0.77, 0.84, 0.73, and 0.81, respectively. The RADs were -4.32%, -10.29%, 4.13%, and 0.34%, respectively, and the ICCs were 0.98, 0.98, 0.97, and 0.98, respectively. All lesions were detected with high PPVs (range 0.94-0.99) and sensitivities (range 0.97-0.99). Conclusions A CNN-based network provides clinicians with quantitative data regarding nAMD through automatic segmentation and detection of pathological lesions, including IRF, SRF, PED, and SHRM.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.007
  • How Are Ocular Signs and Symptoms of Dry Eye Associated with Depression in
           Women with and without Sjögren’s Syndrome'
    • Authors: John A. Gonzales; Annie Chou; Jennifer R. Rose-Nussbaumer; Vatinee Y. Bunya; Lindsey A. Criswell; Caroline H. Shiboski; Thomas M. Lietman
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): John A. Gonzales, Annie Chou, Jennifer R. Rose-Nussbaumer, Vatinee Y. Bunya, Lindsey A. Criswell, Caroline H. Shiboski, Thomas M. Lietman
      Purpose To determine whether ocular phenotypic features of keratoconjunctivitis sicca (KCS) and/or participant-reported symptoms of dry eye disease are associated with depression in women participants enrolled in the Sjögren’s International Collaborative Clinical Alliance (SICCA). Design Cross-sectional study. Methods Women enrolled in the SICCA registry from 9 international research sites. Participants met at least one of five inclusion criteria for registry enrollment (including complaints of dry eyes or dry mouth, a previous diagnosis of Sjögren’s syndrome (SS), abnormal serology (positive anti-Sjögren’s syndrome-related antigen A and/or B (anti-SSA and/or anti-SSB), or elevated anti-nuclear antibody and rheumatoid factor), bilateral parotid gland enlargement, or multiple dental caries). At baseline, participants had oral, ocular, and rheumatologic examination, blood and saliva collection, and a labial salivary gland biopsy (LSGB). They also completed an interview and questionnaires including assessment of depression with the Patient Health Questionnaire 9 (PHQ-9). Univariate logistic regression was used to assess the association between depression and demographic characteristics, participant-reported health, phenotypic features of Sjögren’s syndrome, and participant-reported symptoms. Mixed effects modeling was performed to determine if phenotypic features of KCS and/or participant-reported symptoms of dry eye disease were associated with depression, controlling for health, age, country or residence, and gender and allowing for non-independence within geographic site. Results Dry eye complaints produced a 1.82-fold (95% CI 1.38-2.40) higher odds of having depression compared to being symptom-free (p < 0.001). Additionally, complaints of specific ocular sensations were associated with a higher odds of depression including burning sensation (OR 2.25, 95% CI 1.87-2.72, p < 0.001) compared to those without complaints. In both women with or without SS, the presence of symptoms of dry eyes and/or dry mouth rather than SS itself resulted in higher odds of depression. One particular ocular phenotypic feature of SS, a positive ocular staining score, was inversely correlated with depression. Conclusions Participant-reported eye symptoms, particularly specific ocular sensations such as burning, were found to be positively associated with individual American College of Rheumatology/EUropean Union League Against Rheumatism (ACR/EULAR) SS criteria items.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.004
  • Long-Term Changes in Anterior Segment Characteristics of Eyes with
           Different Primary Angle-Closure Mechanisms
    • Authors: Junki Kwon; Kyung Rim Sung; Seungbong Han
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Junki Kwon, Kyung Rim Sung, Seungbong Han
      Purpose To assess long-term changes in the anterior segment (AS) of eyes with different angle closure mechanisms. Design Retrospective cohort study. Methods In total, 133 eyes (from 75 participants) with angle closure were enrolled. All eyes received laser iridotomy (LI) during the follow-up period. Serial anterior segment optical coherence tomography (AS-OCT) imaging was performed during a mean follow-up of 4 years. Participants were categorized into four groups according to angle closure mechanisms, based on baseline AS-OCT images: pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris roll (TPIR), and exaggerated lens vault (ELV). Linear mixed-effect models were applied to evaluate the longitudinal changes in AS-OCT parameters (anterior chamber depth [ACD], lens vault [LV], and angle opening distance [AOD]). Results Forty-six (35%) eyes were classified as PB, 30 (23%) as PIC, 34 (26%) as TPIR, and 23 (17%) as ELV. The follow-up period was 41−54 months. At baseline, ACD was shallowest in ELV, followed by PB, TPIR, and PIC, in order. The PIC group showed significantly wider AOD than the other groups at baseline. ACD decreased and LV increased over time in all groups, especially in the PIC group. After LI, the angle widened in the PB and TPIR groups, but not in the PIC and ELV groups. Conclusions AS parameters changed differently in the four groups. The effects of LI on AOD also differed among groups. Identification of the angle closure mechanism may help predict progressive changes in AS parameters in eyes with angle closure.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.005
  • Genetic and Phenotypic Traits of S. Epidermidis Strains Causing
           Post-cataract Endophthalmitis Compared to Commensal Conjunctival Flora
    • Authors: Christophe Chiquet; Cécile Musson; Florent Aptel; Sandrine Boisset; Pharm; Max Maurin
      Abstract: Publication date: Available online 11 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Christophe Chiquet, Cécile Musson, Florent Aptel, Sandrine Boisset Pharm, Max Maurin
      Purpose The aim of this study was to compare the virulence and antibiotic resistance traits of Staphylococcus epidermidis strains causing acute post-cataract endophthalmitis to those isolated from the conjunctiva of uninfected control patients. Design Case-control study. Methods We isolated a S. epidermidis strain from each of the 22 endophthalmitis patients, and from 43 of the 72 controls. Species identification was confirmed using both Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and tuf gene amplification and sequencing. Antibiotic susceptibilities were evaluated using the AST-P631 card and the Vitek II® automated system. The S. epidermidis strains were tested for the presence of seven virulence genes (icaA, icaB, icaC, icaD, atlE, aap, and capA), the insertion sequence IS256, and the mecA gene. Results The S. epidermidis strains from the endophthalmitis patients displayed higher prevalence rates for aap, atlE, and mecA gene carriage compared to those of the control group (77% vs. 42%, p=0.007; 100% vs 79%, p=0.02; and 54% vs 11%, p<0.001, respectively). They also harbored the combination of the mecA and icaA genes more frequently compared to the control group (13% versus 2%, p=0.01). They were significantly more resistant than control strains to methicillin, fluoroquinolones, and the aminoglycosides. Conclusions A higher capacity of adhesion to the intraocular lens and formation of biofilms as well as greater resistance to antibiotics were found in S. epidermidis strains causing post-cataract endophthalmitis. The usefulness of such virulence and antibiotic resistance markers warrants further evaluation for prevention, treatment, and prognostic evaluation of S. epidermidis endophthalmitis.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.042
  • Internal limiting membrane peeling in macula-off retinal detachment
           complicated by grade B proliferative vitreoretinopathy
    • Authors: Pauline Foveau; Bertrand Leroy; Jean-Paul Berrod; Jean-Baptiste Conart
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Pauline Foveau, Bertrand Leroy, Jean-Paul Berrod, Jean-Baptiste Conart
      Purpose To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR). Design Retrospective, interventional, comparative case series. Methods: Setting Institutional. Study Population 75 consecutive patients who underwent vitrectomy for primary macula off RD complicated by grade B PVR. Observational Procedures Patients were divided into an ILM peeling (group P) and a no ILM peeling (group NP). Main Outcome Measures Anatomical success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6 months. Results In all, 37 eyes with ILM peeling were included in group P and 38 eyes without ILM peeling were included in group NP. The anatomical success rate after single surgery was higher in group P (89%) than in group NP (66%, p=0.03). Mean final visual acuity was 0.41 ±0.40 logMAR in group P versus 0.43 ±0.22 logMAR in group NP (p=0.82). We found no epiretinal membrane (ERM) formation in group P, whereas five cases of ERM (20%) were detected in group NP (p=0.012). The two groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage. Conclusions ILM peeling during vitrectomy in macula off RD complicated by grade B PVR reduces the need for a second surgery for re-detachment or macular pucker.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.037
  • Long-term choroidal thickness changes in eyes with drusenoid pigment
           epithelium detachment.
    • Authors: Rosa Dolz-Marco; Chandrakumar Balaratnasingam; Sarra Gattoussi; Seungjun Ahn; Lawrence A. Yannuzzi; K Bailey Freund
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Rosa Dolz-Marco, Chandrakumar Balaratnasingam, Sarra Gattoussi, Seungjun Ahn, Lawrence A. Yannuzzi, K Bailey Freund
      Purpose To analyze the changes in visual acuity and subfoveal choroidal thickness in patients with non-neovascular age-related macular degeneration (AMD) and drusenoid pigment epithelium detachments (PED). Design Consecutive observational case series. Methods Observational retrospective review of eyes diagnosed with drusenoid PED in a single clinical setting. Demographic and clinical data included age, gender, laterality, best corrected visual acuity (BCVA) and subfoveal choroidal thickness measured at baseline, before and after the collapse of the PED, and at the last available follow-up. The presence of geographic atrophy (GA) was also assessed. Results Thirty-seven eyes of 25 patients (18 females) were included in the analysis. Mean age at baseline was 71 ± 8.4 years. During a mean follow-up period of 4.9 ±1.9 years, PED collapse was observed in 25 eyes (68%). Mean BCVA, mean maximum PED height and mean subfoveal choroidal thickness significantly decreased from baseline to the last available follow-up (p<0.001) in patients showing PED collapse. Choroidal thinning was faster during the PED collapse (speed rate of 35.9 microns/year). From those, 23 eyes (92%) developed GA. A significant correlation between the area of GA and the decrease in choroidal thickness was found (p=0.010). Conclusions Choroidal thickness significantly decreased in eyes showing drusenoid PED collapse, but not in eyes in which the PED persisted. A significant correlation with resultant GA area following PED collapse and the magnitude of choroidal thinning was found. Further studies are warranted to better understand the mechanisms involved in the occurrence of choroidal changes during the lifecycle of drusenoid PEDs.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.038
  • Angiopoietin-like 3 is a Potential Biomarker for Retinopathy in Type 2
           Diabetic Patients
    • Authors: Cai-Guo Yu; Sha-Sha Yuan; Long-Yan Yang; Jing Ke; Li-Jie Zhang; Jia-Nan Lang; Da-Wei Zhang; Shao-Zhen Zhao; Dong Zhao; Ying-Mei Feng
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Cai-Guo Yu, Sha-Sha Yuan, Long-Yan Yang, Jing Ke, Li-Jie Zhang, Jia-Nan Lang, Da-Wei Zhang, Shao-Zhen Zhao, Dong Zhao, Ying-Mei Feng
      Purpose To investigate whether angiopoietin-like 3 (ANGPTL3) and angiopoietin-like 4 (ANGPTL4) are differentially associated with the severity of retinopathy in patients with type 2 diabetes mellitus (T2DM). Design Cross-sectional study. Methods Serum levels of ANGPTL3, ANGPTL4, high-sensitivity C-reactive protein (CRP), vascular adhesion molecule–1 (VCAM-1), intracellular adhesion molecule–1 (ICAM-1) and vascular endothelial growth factor (VEGF) were quantified by ELISA. Retinal images were recorded to assess the grade of diabetic retinopathy (DR). Multivariable-adjusted logistic analysis was performed to estimate the association of each biomarker and DR stage. Results Among 1192 T2DM patients, 426 (35.7%) had non-proliferative diabetic retinopathy (NPDR) and 56 (4.5%) had proliferative diabetic retinopathy (PDR). After adjusting for covariables, the odds ratios expressing the risk of having DR vs. no DR (n=710 vs. 482) was 1.23 (95% CI, 1.08-1.40, p=0.002) for ANGPTL3; 0.90 (95% CI, 0.79-1.02; p=0.095) for ANGPTL4; and 1.14 (95% CI, 1.00-1.29; p=0.044) for VEGF. The risk of having no DR vs. NPDR (n=710 vs. 426) was 1.16 (95% CI, 1.01-1.32; p=0.036) for ANGPTL3; 0.90 (95% CI, 0.79-1.04; p=0.15) for ANGPTL4; and 1.14 (95% CI, 1.00-1.31; p=0.045) for VEGF. The odds ratios of having NPDR vs. PDR (n=426 vs. 56) was 1.47 (95% CI, 1.03-2.10; p=0.035) for serum ANGPTL3; 0.96 (95% CI, 0.69-1.35; p=0.83) for ANGPTL4; and 1.05 (95% CI, 0.77-1.45; p=0.74) for VEGF. Conclusions ANGPTL3 is independently and strongly associated with DR progression in all stages. Blockade of ANGPTL3 signal in retina might postpone the onset and development of DR in T2DM patients.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.040
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